Practice Information |
|
Organization Legal Name
|
U S HEALTH DEPT OF HEALTH AND HUMAN SERVICES
|
|
Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
|
|
Group Practice PAC ID
|
9638081623
|
|
Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
|
|
Number of Group Practice members
|
84
|
|
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
|
|
Line 1 Street Address
|
10110 S 7650
|
|
Group Practice or individual's line 1 address
|
|
City
|
CROW AGENCY
|
|
Group Practice or individual's city
|
|
State
|
MT
|
|
Group Practice or individual's state
|
|
Zip Code
|
590220009
|
|
Group Practice or individual's zip code (9 digits when available)
|
|
Phone Number
|
4066383416
|
|
Phone number is listed only when there is a single phone number available for the practice location address
|
Hospital(s) Affiliation Information |
|
Hospital Affiliation CCN 1
|
271339
|
|
Medicare CCN of hospital where individual professional provides service 1
|
|
Hospital Affiliation LBN 1
|
P H S INDIAN HOSPITAL CROW / NORTHERN CHEYENNE
|
|
Legal business name of hospital where individual professional provides service 1
|
|
Hospital Affiliation CCN 2
|
271338
|
|
Medicare CCN of hospital where individual professional provides service 2
|
|
Hospital Affiliation LBN 2
|
BIG HORN CO MEMORIAL HOSPITAL
|
|
Legal business name of hospital where individual professional provides service 2
|
|
Professional Accepts Medicare Assignment
|
Y
|
|
|